MEDICARE: KATRYNA MCCOY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	629	AK

General Provider Information

NPI Number	:	1861683534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRYNA MCCOY FNP

Provider Business Mailing Address
First Line	:	PO BOX 13624
Second Line	:
City	:	DES MOINES
State	:	WA
Zip	:	98198-1009
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 S 204TH ST
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98198-3346
Country	:	US
Telephone Number	:	907-543-6300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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